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Schizophrenic psychopathology is heterogeneous and multidimensional. Various strategies have been developed over the past several years to assess and measure more accurately discrete domains of psychopathology. One of the more fruitful strategies to investigate more homogenous domains of psychopathology has been the positive-negative syndrome approach. However, this approach is unable to address a number of important issues. Most schizophrenics present a mixed syndrome; the criteria for what constitutes a positive and negative syndrome are variable; distinguishing primary from secondary negative symptoms can be difficult. In order to address some of these problems, we propose the introduction of a five-syndrome model based on a reanalysis of factor analytic procedures used on 240 schizophrenics assessed with the Positive and Negative Syndrome Scale. We present data on a five-factor solution that appears to best fit the psychopathological data and that is supported by three independent and comparable factor analyses; negative, positive, excitement, cognitive, and depression/anxiety domains of psychopathology give patients their individual mark. Data on internal consistency of the five factors and on initial validation using demographic and clinical variables are presented.
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PMID:Five-factor model of schizophrenia. Initial validation. 796 71

The negative symptoms of schizophrenia have generated a great interest leading some authors (Crow, Andreasen, Kay) to delineate schizophrenic subtypes based on their presence or absence. Carpenter et al. have recently proposed another subtype, the deficit syndrome, based on Kraepelin's clinical description. This differs from other proposed negative subtypes and refers to the presence or absence of prominent, enduring and primary negative symptoms. Primary negative symptoms have to be due to psychophrenia itself, in other words, independent of factors such as depression, anxiety, akinesia... Kirkpatrick et al. have proposed the Schedule for the Deficit Syndrome (SDS) to reliably identify this deficit syndrome. Some studies using this instrument have supported the validity of the deficit syndrome concept. Particularly, deficit patients have clinical, neuropsychological, neurological, eye-tracking and brain imaging impairments compared to nondeficit patients. We realized a french translation of SDS and used it to study a biological index (plasma homovanillic acid, pHVA) among deficit and nondeficit schizophrenic patients. Our data suggest a specific biochemical basis for the deficit syndrome, ie, significant lower mean pHVA levels with a lack of diurnal variation for deficit patients. The french version of SDS was validated by Kirkpatrick after english back translation. We present here our psychometric data regarding reliability (assessed by weighted and unweighted kappa coefficients) and cohesiveness of the construct (assessed by rank-order correlations of each negative symptoms with the other five, using Spearman's rho). These data are quite significant and in agreement with the SDS authors.
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PMID:[Schedule for evaluation of the deficit syndrome in schizophrenia: Schedule for Deficit Syndrome (SDS) (Kirkpatrick et al.). Importance pertinence of the SDS. Introduction of the French version]. 798 5

Forty-two patients with posttraumatic headache of at least three months duration following motor vehicle accident completed the Postconcussion Syndrome Checklist which assessed their experience of 10 commonly reported cognitive, emotional, and physical symptoms. The patients also completed the Beck Depression Inventory and a brief battery of neuropsychological tests. Results indicated that postconcussion symptoms remained quite prevalent among these subjects. More pronounced postconcussion symptomatology was associated with significantly greater impairment on 6 of 13 measures of neuropsychological functioning. Neither severity of subjects' postconcussion symptoms nor neuropsychological test performance were affected by litigation status. However, depressed subjects reported more severe cognitive and emotional symptoms than did nondepressed subjects. Additional information about postconcussion symptom prevalence and a description of the relationship between self-reported symptoms, cognitive functioning on neuropsychological tests, and depression is provided. The implications of these findings are discussed.
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PMID:Postconcussion symptoms and cognitive functioning in posttraumatic headache patients. 800 21

Fifteen DSM-III-R diagnosed schizophrenics characterized by long-term neuroleptic nonresponse and significant negative symptoms were evaluated with the Positive and Negative Syndrome Scale, a well-operationalized measure of psychopathology, on a baseline neuroleptic and weekly thereafter across 26 weeks of clozapine treatment in order to explore clozapine's effect on other domains of schizophrenic psychopathology beyond its effect on positive symptoms. Mean differences from baseline indicated significant improvement on positive, negative, cognitive, excitement, and depression subscales after 12 weeks. Improvement observed after 12 weeks of clozapine treatment reliably predicted scores observed at week 26. There were no further significant improvements on any symptom profile, including positive and negative symptoms, in this long-term, nonresponder group between weeks 12 and 26. Overall, clozapine proved to affect a broad spectrum of discrete and nonoverlapping domains of psychopathology in this schizophrenic sample.
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PMID:Clozapine effects on positive and negative symptoms: a six-month trial in treatment-refractory schizophrenics. 802 17

Memory and likeability ratings for emotion-laden and neutral stimuli were investigated in Korsakoff amnesics, former heavy drinkers and light drinkers. Tasks were recall of self-generated paired-associates, primed recognition and likeability ratings for faces previously paired with emotional or neutral descriptors, and ratings of the emotionality of items in a 64-word list. The Profile of Mood States and Geriatric Depression Scale were also administered. Despite severely impaired recall in Korsakoff's amnesics, the effects of emotional versus neutral material were not distinguishable among the three groups. These findings indicate a need to re-examine the notion that flattening of emotional responsiveness is a central characteristics of Korsakoff's Syndrome.
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PMID:Evidence of normal emotional responsiveness in alcoholic Korsakoff's syndrome in the presence of profound memory impairment. 813 Jul 2

Self-assessment scales have long been used in psychiatric research even if their validity has often been questioned, one reason being poor the concordance of expert ratings. In clinical practice the use of rating scales is restricted, since they are considered to be time-consuming and perhaps even to disrupt the clinician's rapport with the patient. In the present study, a self-assessment scale, the CPRS Self-rating Scale for Affective Syndromes (CPRS-S-A), was constructed by re-phrasing in a self-rating format 19 items from the original Comprehensive Psychopathological Rating Scale (CPRS) and covering depression, anxiety and obsessional symptoms. In a group of 30 patients with depression syndromes and anxiety syndromes, the CPRS-S-A and the original CPRS were both used on 2 occasions. The patient's Global Assessment of Functioning scores ranged from 30 to 76 (mean 58), which suggests a moderate severity of illness, as does the fact that the majority were outpatients. There was a high degree of concordance between the instruments for most items and for the scores on the subscales for both diagnostic groups (i.e., the Montgomery-Asberg Depression Rating Scale and the Brief Anxiety Scale, which are both subscales drawn from the CPRS). The time taken to complete the CPRS-S-A varied from 5 to 30 min (mean 19 min for depressive and 16 min for anxiety patients on the first occasion, 13 min for both groups on the second), and the self-rating procedure was readily accepted by both groups of patients. The CPRS-S-A would thus seem to be a promising instrument for quantitative rating of symptoms in ambulatory patients, both in clinical practice and in research.
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PMID:A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. 814 Sep 3

This study sought to determine the specificity of the Calgary Depression Scale (CDS), a depression rating scale for schizophrenics. The specificity is the degree to which the scale assesses depression rather than negative or extrapyramidal symptoms. Subjects were 100 outpatients (OP) and 50 inpatients (IP) meeting DSM-III-R criteria for schizophrenia. Negative symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS); extrapyramidal symptoms were assessed with the Simpson Angus Scale (SA) and depression with the CDS. Results were that the CDS showed no correlation with SA, but weak (0.33) statistically significant correlations with the PANSS negative symptom score in inpatients but not outpatients. Confirmatory factor analysis using Lisrel 6.0 showed that the model hypothesizing specificity of depression, negative symptoms and extrapyramidal symptoms, was significant, with a goodness of fit index of 0.89 and a root mean square residual of 0.07. It is concluded that the CDS achieves a useful degree of separation between measures of depression, negative and extrapyramidal symptoms in subjects with schizophrenia, when combined with the other measures used in this study.
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PMID:Specificity of the Calgary Depression Scale for schizophrenics. 819 62

The longitudinal association of several syndromal diagnoses is very frequently a direct consequence of modern descriptive diagnosis. Comorbidity in this sense is clinically relevant. Comorbid cases are more severe, are more amenable to treatment and are more frequently suicidal. The level of association between psychiatric syndromes can lead to nosologic hypotheses that can be further examined by independent investigations, and especially by means of family studies. Generalized anxiety disorders are very closely associated with the affective disorders, particularly with depressions and suicide attempts, but also with hypomania. There is no close relationship with panic disorder. Social phobias are highly associated with agoraphobia, but also with simple phobia; also with panic, obsessive-compulsive syndromes and substance abuse. The prevalence of obsessive-compulsive syndromes depends to an exceptional degree on the definition. Syndromes below the diagnostic threshold of DSM-III are extremely frequent, and longitudinally a fluctuation about this threshold is apparent. OCS are especially found to be associated with social phobia and agoraphobia as well as with dysthymia and recurrent brief depression, but less with major depression.
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PMID:Comorbidity of anxiety, phobia, compulsion and depression. 825 49

Individuals with persisting pain often present a constellation of symptoms that includes pain, health-related impairment and dysphoric mood. It is now widely accepted that comprehensive assessment must address each of these dimensions. Despite recognition of the value of multidimensional assessment, no empirical efforts have validated the construct of a multidimensional clinical outcome presentation based on the dimensions of pain, impairment and dysphoric mood. We employed cluster analytic procedures on standard measures of pain, impairment and depression in chronic low back pain (CLBP) patients (n = 96) attending a general orthopedic clinic in order to empirically characterize multidimensional clinical outcomes. Results indicated that 3 groups could be identified reliably: (1) 'Chronic Pain Syndrome' (n = 25; high levels of pain, impairment and depression), (2) 'Positive Adaptation to Pain' (n = 24; high levels of pain with low levels of impairment and depression) and (3) 'Good Pain Control' (n = 47; low levels of pain, impairment and depression). The reliability of this cluster solution was supported by several tests of internal consistency. Discriminability of the clusters was examined across both the outcome measures themselves and several additional independent variables. The cluster solution was then cross-validated in an independent sample of pain clinic CLBP patients (n = 180) to test its generalizability. Finally the stability of the cluster dimensions over time was tested by re-assessing 36 CLBP patients 6 months after they initially were characterized into 1 of the 3 outcome groups on the same measures. MANOVA results indicated that the outcome groups were differentiated statistically across assessments. The multiple outcome measures did not change significantly across time, nor did the outcome groups change differentially across time on these measures. We conclude that the outcome dimensions of pain, impairment and depression are relatively stable phenomena that differentially describe CLBP patients.
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PMID:An empirical evaluation of multidimensional clinical outcome in chronic low back pain patients. 827 3

Complex visual hallucinations are usually a sign of acute psychopathology or gross cognitive impairment, but may also occur in people with visual deficits--the Charles Bonnet Syndrome. The mental state of 14 Charles Bonnet hallucinators was assessed using four psychological tests: the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Mini-Mult, and the Mini-Mental State Examination. Results are consistent with earlier reports suggesting that these hallucinations are not due to psychopathology or compromised cognitive functioning. It is proposed that these complex visual hallucinations represent ongoing neural activity in the visual system following eye damage.
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PMID:Visual hallucinations and mental state. A study of 14 Charles Bonnet syndrome hallucinators. 840 63


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